Which physical findings are characteristic of tetralogy of Fallot (TOF) in adults?

Updated: Nov 13, 2018
  • Author: Shabir Bhimji, MD, PhD; Chief Editor: Yasmine S Ali, MD, FACC, FACP, MSCI  more...
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As tetralogy of Fallot (TOF) progresses in adults, exertional dyspnea, syncope, palpitations, and evidence of right heart failure such as elevated jugular venous pressure (JVP), ascites, peripheral edema, and hepatomegaly may be noted. Closer examination may also reveal the presence of a large "A wave" in the JVP tracing. This A wave occurs as a result of atrial contraction in late diastole; an abnormally large A wave is typically visible to the eye and denotes increased resistance to right atrial emptying as a result of right ventricular (RV) hypertrophy, which can be seen in severe pulmonary stenosis.

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